Biomedical subjects
Publications and source records attributed to J P Steinig.
Traumatic transection of the base of the tongue can be a life-threatening injury because of blood loss and airway obstruction. Airway control, hemostasis, and meticulous anatomic repair are necessary to prevent speech and airway dysfunction. Laryngeal injuries, when present, require these same principles.
The objective was to evaluate the need for presacral drainage in low velocity penetrating rectal injury. Standard management of penetrating injuries to the extraperitoneal rectum from high velocity injury consists of debridement, diversion, drainage, and distal washout. A retrospective, descriptive review of penetrating rectal injury from 1983 to 1993 was undertaken. Independent variables included age, sex, injury severity score, mechanism of injury, caliber of weapon, associated injuries, pre-/intra-/postoperative antibiotics, length of stay, and presacral drainage. Dependent variables included wound infection and intra-abdominal abscess. Twenty-two consecutive patients met inclusion criteria. Mean injury severity score was 14.2 (SD +/- 2.3). Proximal colostomy was performed on 20; distal washout in 12 (60%). Eight (40%) of the 20 underwent presacral drainage; 12 (60%) did not. Use of presacral drainage was based on attending surgeon's preference. Groups were comparable regarding all independent variables. Routine use of presacral drainage in managing low velocity rectal wounds may not be necessary. Absence of drainage did not increase infectious complications.
A 5-year retrospective study of 530 motor vehicle fatalities revealed 105 aortic injuries occurring in 90 victims. These were reviewed to determine the injury patterns, circumstances, and mechanisms involved. In addition, the survival time, the driver's age and sex, the time of day of the accident, and the blood alcohol level were considered. The aortic injuries consisted of 61 transections and 44 tears (13% were multiple). Sixty-five percent of the injuries were located in the proximal descending aorta (66% of these were transections), 14% were in the ascending aorta and arch (33% of these were transections), 12% were in the distal descending aorta (more than 1 cm distal to the subclavian artery) (46% of these were transections), and 9% were in the abdominal aorta (56% of these were transections). Associated injuries consisted of multiple rib fractures (78%), liver lacerations (61%), head injuries (42%), first rib fractures (42%), splenic lacerations (36%), heart lacerations (34%), sternal fractures (28%), cervical spine fractures (26%), and thoracic spine fractures (20%). Death occurred within 1 hour in 94% and within 24 hours in 99%. The impact was head-on in 62% of the accidents. The victim was the driver 74% of the time and male in 77% of the cases, and the blood alcohol level exceeded 0.1 mg/dL in 43%. Most aortic disruptions were complete transections of the proximal descending aorta, associated with serious injury to the thorax, and occurred in head-on collisions. Findings support a compression and upward thrust of the heart as a mechanism responsible for the aortic disruption.
Although rare, tropical pyomyositis can result from staphylococcal bacteremia and should be considered in the different diagnosis of fever associated with extremity pain. The diagnosis is readily made with a CT scan. Treatment is primarily medical with surgery reserved for refractory abscesses.